Malignant Lymphoma of Mucosa-Associated
Lymphoid Tissue (MALT) Type Associated with
Ascariasis in the Liver
著者
YAMABE Hirohiko, HAGA Hironori, KASHU Ippei,
WATANABE Chihiro, KOBASHI Yoichiro
journal or
publication title
鹿児島大学医学雑誌=Medical journal of
Kagoshima University
volume
47
number
Suppl. 2
page range
137-139
URL
http://hdl.handle.net/10232/18332
Med. J. Kagoshima Univ., Vol. 47, Suppl. 2. 137-139, November, 1995
Case Report
Malignant Lymphoma
of Mucosa-Associated Lymphoid Tissue (MALT) Type
Associated with Ascariasis in the Liver
Hirohiko YAMABE1,
Hironori HAGA1, Ippei KASHU1, Chihiro WATANABE1
and Yoichiro KOBASHI2
laboratory of Anatomic Pathology, Kyoto University Hospital, Kyoto, Japan
2Department of Pathology, Tenri Hospital, Nara, Japan
Abstract
A 57-year-old woman with a low-grade mucosa-associated lymphoid tissue (MALT) type lymphoma in the biliary system of the liver is reported. This lesion was accompanied by a long-standing biliary ascariasis in the center of the lesion. Lymphoma cells showed marginal zone distribution, lymphoepitheHal lesions in the bile ducts, centrocyte-like and monocytoid fea tures, and a B-cell phenotype. Follow-up study revealed no evidence of disease 4 years and 7 months after surgery.
Key words: MALT type lymphoma, Liver, Ascariasis
Introduction
Primary lymphomas in the liver and biliary tract are very rare and account for only 0.4% in a large series of
1,467 cases of extranodal lymphomas1^ Aozasa et al.
found only 69 reported cases of primary hepatic malignant lymphomas in the literature and noted that diffuse large cell B-cell lymphomas were the mostcommon2). Primary lymphomas of the biliary system
are also reported to be extremely rare3,4\ most being
high-grade lymphomas3^
Among extranodal lymphomas, a considerable
proprotion is now believed to be lymphoma of the
mucosa-associated lymphoid tissue (MALT) type
recently described by Isaacason and Wright5). MALT
Address for Correspondence: Hirohiko YAMABE, M.D. Laboroatory of Anatomic Pathology, Kyoto Universiy Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto
606-01, Japan
type lymphomas are considered low-grade lymphomas of B-cell origin with favorable clinical course in contrast to high-grade or large cell lymphomas.
We herein report a case of low-grade lymphoma of the MALT type occrring in the biliary system of the
liver which was associated with ascariasis.
Case report
The patient was a 57-year-old housewife. In the family history, her father had diabetes mellitus, her mother had cholangiocarcinoma, and her sister had cardiac infarct. The patient had cesarean section at 31 years of age. She had been well until about 10 years ago, when she first noticed intermittent pain in the right epigastric region. A diagnosis of chronic hepatitis was
made at that time, but she received no treatment. In a
health check-up in February 1990, a calcified tumor was incidentally found in the right lobe of the liver by plain x-photo and computed tomography (CT). She was admitted to Kyoto University Hospital for further
examination and treatment. The CT scan and the
magnetic resonance imaging (MRI) (Fig. 1) revealed an irregular calcified mass in the S7 and S8 area of the right hepatic lobe. Cholangiocarcinoma was suggested as a clinical diagnosis, but reactive inflammatory process, hemangioma, and metastatic tumor were among the differential diagnosis. Blood chemistry and serology data were unremarkable except for a slight elevation of 7 -GTP value and positive HBsAb. (Total protein 7.7 g/dl, albumin 4.5g/dl, total bilirubin 0.6mg/dl, GOT 28 IU/L, GPT 18 IU/L, ALP 177 IU/L,
7-GTP 54 IU/L, ChE 361 IU/L, LDH 394 IU/L,
HBsAg(-), HBsAb( + ), CEA(-), AFP(-)). Right
lobectomy of the liver was performed on April 18, 1990. No lymph node swelling was found. Pathological
[138] Med. J. Kagoshima Univ., Vol. 47, Suppl. 2, November, 1995
1. T2-weighted magnetic resonance imaging scan
showing a high signal of the tumor with central low signal area.
diagnosis of a low-grade lymphoma of the MALT type
associated with ascariasis was made. No further
treatment was given. The patient was well at a regular check-up on November 7, 1994, 4 years and 7 months
after surgery.
Pathology
The resected tumor was located in the S7 and S8
area. It was well circumscribed and measured 6.5 X 7
X 8cm. The cut surface was solid, elastic hard and
yellowish white with penetration of blood vessels and bile ducts and a central calcification (Fig. 2). Microsco pic examination showed multiple nodular configuration of lymphoid cell proliferation containing germinal centers (Fig. 3). Proliferating cells were located outside the reactive germinal centers which were accompanied by remnants of mantle zones in some areas. These cells showed atypical centrocyte-like and monocytoid fea tures (Fig. 4, 5). The so-called lymphoepitheHal lesion was also found easily in the interlobular bile ducts (Fig. 4). Immunohistochemical studies revealed that the tumor cells were L26 (CD 20, DAKO, Japan) positive
Fig. 2. Gross picture of the tumor.
and CD3 (polyclonal, DAKO, Japan) negative. In the calcified area, there was a dead parasite with thick-shelled oval eggs mesuring 40 —45X50 —55 ,«m with out operculum, which was most probably ascaris (Fig. 6). From these findings, we concluded this was a low-grade MALT type lymphoma of the biliary system in
Fig. 4. Centrocyte-like lymphoma cells showing lym phoepitheHal lesions. (H & E, X 350)
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Fig. 5. Lymphoma cells with monocytoid features. (H & E, X 700)
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Fig. 6. A parasite (Ascaris) with eggs in the center of the lymphoma. (H & E, X 70)
the liver which developed in a setting of biliary ascariasis.
Discussion
Malignant lymphomas in the liver and biliary system
are very rare'"4'. If they occur, most such lymphomas
are large cell or high-grade lymphomas2"'. To our
knowledge, there is no prior report of low-grade MALT type lymphoma in the hepatic biliary system, although a few cases have been reported in the
gallbladder3'4'. The concept of MALT type lymphoma
presented by Isaacson and Wright has now been wellaccepted4"7'. The present case fulfils the histological
criteria of low-grade MALT type lymphoma . This case is peculiar in that a long-standing biliary ascariais was found in the center of the lymphoma. We have no idea about the relationship between the lesions, but it is very reasonable to speculate that the long-standing inflammatory process caused by ascaris was a forerun ner of the lymphoma, since MALT type lymphomas occurring in the stomach, thyroid and salivary gland are thought to have some histogenetic relationship to the chronic inflammatory lesions often seen in the background of these lymphomas8"10'.
References
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